Femoral fracture load and fracture pattern is accurately predicted using a gradient-enhanced quasi-brittle finite element model

Nonlinear finite element (FE) modeling can be a powerful tool for studying femoral fracture. However, there remains little consensus in the literature regarding the choice of material model and failure criterion. Quasi-brittle models recently have been used with some success, but spurious mesh sensitivity remains a concern. The purpose of this study was to implement and validate a new model using a custom finite element designed to mitigate mesh sensitivity problems. Six specimen-specific FE models of the proximal femur were generated from quantitative tomographic (qCT) scans of cadaveric specimens. Material properties were assigned a-priori based on average qCT intensities at element locations. Specimens were experimentally tested to failure in a stumbling load configuration, and the results were compared to FE model predictions. There was a strong linear relationship between FE predicted and experimentally measured fracture load (R2= 0.79), and error was less than 14% over all cases. In all six specimens, surface damage was observed at sites predicted by the FE model. Comparison of qCT scans before and after experimental failure showed damage to underlying trabecular bone, also consistent with FE predictions. In summary, the model accurately predicted fracture load and pattern, and may be a powerful tool in future studies.